LONGMONT -- When Paul Martinez Sr. sees the doctor pull up to his home in a black Volvo, he sees what might as well be the Lone Ranger on a white horse.
Before Martinez found House Call Physicians in Longmont, he and his wife, Fiorella Martinez, spent the better part of a day preparing their son for ambulance rides to various appointments.
Now, Dr. Brian Mathwich comes to their door as if they lived in a bygone era when house calls were the standard of care.
"But this is not a concierge service," Mathwich, 51, said.
All of his patients must undergo an eligibility evaluation to prove that they need to make a "considerable and taxing effort" to keep doctor appointments.
Paul Martinez Jr., 23, fits that category.
The Longmont man suffered a heart attack and brain damage after someone slipped an animal tranquilizer into his drink at a 2008 New Year's eve party, according to Paul Martinez Sr.
Now he's entirely dependent on his father and stepmother to meet his basic needs.
Typically, though, a House Call Physicians' patient is much older. A breakdown by age shows 83 percent are older than 65; 15 percent older than 50; and only 2 percent under age 50.
He drives about 100 miles daily to visit patients living at home with a family caregiver or receiving care from one of the 18 home health care agencies or 12 hospice agencies in Boulder, Larimer and Broomfield counties that partner with his practice.
"Some of our demented folks, just getting them ... to the office, it can take them three days to calm down," he said. "This is a totally different experience. A patient can stay at home and sit on their couch holding their cat during the visit."
Mathwich established House Call Physicians in Longmont in 2010 after 15 years at a traditional practice when technology improvements made returning to the old-fashioned house call practical.
He brings a laptop computer and
His ballpoint pen helps, too, Paul Martinez Sr. said.
The doctor has saved the Martinez family many trips by signing off at their kitchen table on the slew of paperwork they face, be it the rare wheelchair refitting or the regular evaluations.
Despite the patient need and the technology recently available to make house calls more practical, Mathwich acknowledges the challenge of making this new business model work without university affiliation or grant-funded nonprofit status.
Medicare pays 30 percent less than commercial insurance and Medicaid pays 47 percent less commercial insurance, House Call Physicians office manager Stephanie Hales said.
Mathwich joined The American Academy of Home Care Physicians for guidance when he launched the practice.
"But there aren't enough numbers out there or big enough practices to generate accurate, detailed business benchmarks," Mathwich said.
To make his bottom line, he uses his business acumen -- Mathwich finishes a master's degree in health care business administration this fall -- and focuses the efficiencies that come from delivering care before a small issue, such as a urinary tract infection, leads to an emergency room visit.
So far, the strategy works.
House Call Physicians employs six staff with the potential to add a new provider every four months, Mathwich said.
Rella Marcantonio, a Longmont resident who turns 92 Friday, called Mathwich a "godsend."
During a routine visit in mid-July, she sat in her favorite chair surrounded by photos of her grandchildren -- in pumpkin patches and petting horses -- while he sat across from her and pulled up her chart on his laptop computer.
But so does he by getting a better sense of his patients than he would under the fluorescent lights of a small office with paper on the exam table.
"One of my patients actually knew Buffalo Bill," he said. "And working with this population is the only job where I still get to be called 'kid.'"
Pam Mellskog can be reached at 303-684-5224 or at email@example.com.
For more information, visit http://hcphysicians.com.